Baseline gut microbiota and short-term response to acupressure combined with thermal stimulation in maintenance hemodialysis patients with functional constipation: an exploratory responder analysis.
Chen S, Wu M, et al. • Frontiers in cellular and infection microbiology • 2026
Baseline microbial diversity and community structure were similar between responders and non-responders to acupressure combined with thermal stimulation in hemodialysis patients with functional constipation; Veillonella and Lactobacillus showed adjusted associations with response but were not robust in sensitivity analysis, so the findings are exploratory rather than predictive.
Key Findings
Results
Only about one-third of the 26 maintenance hemodialysis patients with functional constipation met the predefined response criterion after the 14-day acupressure plus thermal stimulation intervention.
Twenty-six participants were included; 9 (34.6%) were classified as responders (increase of ≥1 bowel movement per week).
The remaining participants were non-responders (<1 BM/week increase).
This was a responder analysis based on a randomized two-sequence crossover study, using baseline data and fecal samples collected immediately before each participant entered the 14-day intervention period.
Results
Across all participants, bowel movement frequency increased and constipation symptom scores decreased after the intervention.
Weekly BM frequency rose from 1.25 (1.00, 1.50) to 2.00 (1.00, 3.00) (P = 0.0003).
Baseline alpha-diversity did not differ significantly between responders and non-responders.
Microbial diversity was assessed using 16S rRNA gene sequencing of baseline fecal samples.
The authors conclude baseline microbial diversity was similar between groups.
Results
Baseline beta-diversity showed no overall community separation between responders and non-responders.
ANOSIM R = -0.044, P = 0.6751.
Taxonomic composition and community structure were similar between groups.
Results
Lactonifactor was nominally higher in responders in the unadjusted analysis but did not survive multiple-testing correction.
Unadjusted P = 0.015.
After Benjamini-Hochberg correction, FDR = 0.86.
Results
In adjusted ANCOM-BC2 analysis, Veillonella and Lactobacillus were associated with responder status, but neither association was robust to pseudocount sensitivity analysis.
Veillonella: β = 5.319, FDR = 0.0347.
Lactobacillus: β = 3.621, FDR = 0.0459.
Models were adjusted for baseline BM/week, sex, and diabetes mellitus, with Benjamini-Hochberg FDR correction.
Neither association held in the pseudocount sensitivity analysis.
Results
PICRUSt2 predicted functional profiling found no significant between-group differences in pathways.
Functional pathways were inferred from 16S rRNA data.
No significant differences were identified between responders and non-responders.
Conclusions
The authors conclude the microbiota findings are exploratory rather than predictive and require validation in larger longitudinal studies.
Small sample (n = 26) with 9 responders.
Genus-level associations were not robust in sensitivity analysis.
Larger longitudinal studies are needed to validate the findings and determine clinical relevance.
What This Means
This study looked at whether the bacteria living in the gut of people on long-term hemodialysis could help explain who benefits from a non-drug constipation treatment combining acupressure with heat (thermal) stimulation. Twenty-six patients with functional constipation received the 14-day treatment, and about one-third (9 patients) had an increase of at least one bowel movement per week. On average, the whole group had more bowel movements and fewer constipation symptoms after treatment.
The researchers compared gut bacteria measured before treatment between those who responded and those who did not. Overall bacterial diversity and community makeup looked similar in the two groups, and predicted bacterial functions did not differ. Two bacterial genera, Veillonella and Lactobacillus, appeared linked to responding after statistical adjustment, but these links did not hold up when the analysis was tested in a different way, so they cannot be considered reliable.
This research suggests that baseline gut bacteria cannot yet be used to predict who will benefit from this treatment. The sample was small, and the authors describe the results as exploratory. Larger studies that follow patients over time are needed to confirm whether any gut bacteria patterns are clinically meaningful.
Chen S, Wu M, Huang M, Lu B, Wang J, Liu H, et al.. (2026). Baseline gut microbiota and short-term response to acupressure combined with thermal stimulation in maintenance hemodialysis patients with functional constipation: an exploratory responder analysis.. Frontiers in cellular and infection microbiology. https://doi.org/10.3389/fcimb.2026.1803544